Suicide mortality in metabolic dysfunction–associated liver diseases: a nationwide cohort study

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated alcohol-related liver disease (MetALD) are becoming more recognised as common chronic liver conditions. Despite this, their relationship with suicide mortality has not been thoroughly investigated.Methods We conducted a nationwide population-based cohort study involving 4,348,487 Korean adults who underwent health screening in 2012. Participants were categorised into four groups based on fatty liver index, metabolic risk factors, and alcohol consumption: no steatotic liver disease (no SLD, n = 3,794,988), MASLD (n = 450,600), MetALD (n = 81,079), and alcohol-associated liver disease (ALD, n = 21,820). We utilised Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for suicide mortality. Participants were followed until death or the conclusion of the study period.Results During a median follow-up of 9.2 years, 9,830 participants died by suicide. Compared to individuals without SLD, the adjusted HRs for suicide mortality were significantly elevated across all SLD subtypes: 1.20 (95% CI: 1.12–1.29) for MASLD, 1.39 (95% CI: 1.23–1.57) for MetALD, and 1.39 (95% CI: 1.11–1.74) for ALD. A dose-dependent increase in suicide mortality was observed with higher levels of alcohol consumption. Even among individuals with low alcohol intake, SLD remained associated with a higher risk of suicide compared to non-SLD (HR: 1.24; 95% CI: 1.15–1.33).Conclusions Both MASLD and MetALD were associated with a higher risk of suicide mortality. These findings highlight the combined effects of metabolic dysfunction and alcohol use on suicide risk within these populations.